Perforated colonic diverticulum: what should a surgeon do?

Perforation of a colonic diverticulum remains a significant challenge in modern surgical practice and is frequently encountered in the management of patients with acute abdominal conditions. Objective. To evaluate current approaches to the surgical management of patients with perforated colonic diverticula based on a comprehensive literature review. Key points. A literature search was conducted in PubMed, Scopus, Web of Science, eLibrary, and CyberLeninka databases covering the period from 2012 to 2024 using the following keywords: diverticular disease of the colon, colonic diverticula, perforated colonic diverticulum, and surgical treatment of perforated colonic diverticulum. Based on the analysis of the selected publications, current evidence on various surgical approaches and their effectiveness in patients with perforated colonic diverticula was summarized. Expert opinions, clinical practice guidelines, and results of multicenter studies addressing key aspects of surgical management were also reviewed. Conclusions. Surgical treatment of perforated colonic diverticula is currently largely based on minimally invasive techniques. However, in severe cases, an open surgical approach remains more appropriate. The development and implementation of novel technologies aimed at improving outcomes in patients with perforated diverticular disease represent a promising direction and require further validation in multicenter studies.